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Anesth Analg 2007; 105:1749-1752
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000290293.13532.60
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GENERAL ARTICLES

Flat Electroencephalogram Caused by Carbon Dioxide Pneumoperitoneum

Hitoshi Yoshida, MD, PhD, Tetsuya Kushikata, MD, PhD, Shizuko Kabara, MD, PhD, Hajime Takase, MD, Hironori Ishihara, MD, PhD, and Kazuyoshi Hirota, MD, PhD

From the Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan.

Address correspondence and reprint requests to Hitoshi Yoshida, MD, PhD, Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8562, Japan. Address e-mail to hyoshida{at}cc.hirosaki-u.ac.jp.

Hypercapnia during laparoscopy with CO2 is predicted in the following situations: compromised pulmonary function, retroperitoneal insufflation, and subcutaneous emphysema. We present a case of sudden electroencephalogram (EEG) depression in response to severe hypercapnia during laparoscopic ureteronephrectomy in a 77-yr-old patient with chronic pulmonary emphysema. During intraperitoneal and retroperitoneal insufflation, subcutaneous emphysema and difficult ventilation occurred. Severe hypercapnia ensued, with pH = 6.94, and Paco2 = 137 mm Hg. Subsequent EEG activity was markedly depressed with a minimum Bispectral Index of 4, accompanied by an increase in arterial blood pressure and heart rate. Termination of the laparoscopic procedure improved ventilation, EEG, and hemodynamics. These EEG changes may result from the narcotic properties of CO2 or hypercapnia-induced neurological abnormalities.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.